Provider Demographics
NPI:1467629618
Name:BAKER EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:BAKER EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DEARBORN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-376-1637
Mailing Address - Street 1:49 LOCUST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2239
Mailing Address - Country:US
Mailing Address - Phone:978-376-1637
Mailing Address - Fax:
Practice Address - Street 1:49 LOCUST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2239
Practice Address - Country:US
Practice Address - Phone:978-376-1637
Practice Address - Fax:978-304-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353027Medicaid
MA110072761AMedicaid
D09427OtherRAILROAD MEDICARE
W20157OtherBCBS
W15607OtherBCBS
MA0353027Medicaid
W20157OtherBCBS